CATARACTS: Age, injury, medication and genetics are among the causes.

January 24, 2006.
Orangeburg Times Democrat - Orangeburg,SC,USA.

A painless blurring of vision. Glare or sensitivity to light. Frequent changes in contact lens or eyeglass prescriptions.

What do these symptoms have in common? They all are signs that you may have one of the world’s leading causes of blindness. The American Academy of Ophthalmology reports that approximately 20.5 million Americans age 40 and over suffer with cataracts.

Though serious and fairly common, cataracts are one of the most curable causes of vision loss.

During January, as Cataract Awareness Month, optometrists across the nation are explaining this prevalent condition and reminding sufferers that they don’t have to live their lives in a fog.

Cataracts are the clouding of the eye’s clear lens, similar to a window fogged with steam. When the lens become cloudy, light rays cannot pass thorugh it easily and vision becomes blurry. Cataracts are not a growth or a film over the eyes.

More than half of all Americans develop cataracts by age 80. While they usually develop as a natural part of the aging process, cataracts can also result from:

-- eye injuries

-- certain diseases, including diabetes

-- genetic inheritance

-- certain medications

-- frequent, unprotected exposure to UV-A and UV-B rays

-- smoking

“When we get to the point where changes in the lens of the eye cut our vision down to where we can no longer function like we want, or are not able to see what we want to see, then something needs to be done about the cataract,” said Dr. Angela Abraham-Nichols, an optometrist with the Orangeburg-based Wright Eye Institute on Amelia Street.

“Medication can indeed influence changes in the lens of the eye to cause cataracts,” she said. “A lot of people who are on the steroid prednisone will develop cataracts earlier and faster.

“Steroids are used in treating so many different kinds of diseases. What I’m more aware of now is children who are on oral steroids for asthma. I watch them a lot closer now; it’s something to be mindful of.

“An injury to the eye can also speed up the process (through which cataracts develop), sometimes overnight. If you get hit in the eye with a baseball, for example, there’s a possibility that you can develop one. I’ve seen that as well,” she said.

While there are no medications or exercises that will cause cataracts to disappear, surgery is an option for people whose daily activities are being affected. The American Academy of Ophthalmology reports that cataract surgery is one of the nation’s most frequently performed surgeries, with more than 1.6 million performed each year.

“The leading type of cataract surgery now is called phacoemulsification,” Abraham-Nichols said.

This 19-letter word refers to the use of ultrasound to break the eye’s natural crystalline lens into pieces for removal through a small incision. The incision is made either at the far edge of the cornea, or in the sclera (the white of the eye), and is also used for the placement of the new intraocular lens, or implant.

“A lot of times that implant can be calculated where you don’t necessarily have to wear glasses anymore, or you’ll just have to wear glasses for reading. A lot of patients liken it to refractive surgery, but it doesn’t work like that,” she said, noting that blurred vision isn’t necessarily the cause of cataracts.

Confusion about the condition is even more reason for people to develop a good relationship with their doctor, Abraham-Nichols said, advising patients to be sure they explain their symptoms completely and understand the diagnosis before immediately settling on having cataract surgery.

“One of my patients, for instance, had some other things going on like glaucoma,” she said. “He had cataracts, but they just weren’t that bad and weren’t necessarily affecting his vision. We needed to find out why he wasn’t able to see,” she said.

The patient, 91, travels many miles from his home in Harleyville for his eye appointments.

“As you develop a cataract, you don’t necessarily have to have it removed,” she said. “You don’t have to wait like years ago, when they say it’s ‘ripe,’ but you want to wait until your vision gets to the point where you can no longer do the things you were doing before.

“You and your doctor will then decide where to turn. It’s best to wait before having cataract surgery to see if your glasses perhaps just need to be changed, or if it’s something else bothering your vision,” she said.

One of her youngest cataract patients was an 8-year-old who suddenly lost her vision. She had a full-blown cataract, but investigation revealed that she also had juvenile arthritis. An inflammation had set up the cataract, which Dr. Abraham-Nichols removed.

There’s a great need for education about cataracts in the Orangeburg area, the doctor said. She speaks to individuals everywhere from assisted living centers to daycare and preschools about the importance of caring for their eyes.

“If you’ve never had an eye exam, you don’t know what you can and can’t see. My son’s daycare is doing a career day this month. I’ll go and talk about eye care and, hopefully, we can get kids interested in the health of their eyes early,” she said.